The questions came up soon after the first study of XMRV in chronic fatigue syndrome -- should people with chronic fatigue syndrome give blood ?

Canada says "no."Canadian Blood Services acknowledges that there's no conclusive link between the retrovirus and chronic fatigue syndrome or any other disease for that matter, but the agency says it prefers to err on the side of caution.It's the first country to make this move.

I'm sure some of us are worried about a stigma that could arise from something like that and I think it is a valid concern.However, it seems to me like a choice between being considered "crazy" and "infectious".Yeah, it's lousy either way, but at least people can't say you aren't sick and be afraid of catching it at the same time.That kind of stigma is bound to be the flip side of the condition being validated as an infectious viral disease.

Overall, though, I think the Canadian folks have probably made a wise decision.If research eventually finds XMRV doesn't cause disease, fine -- lift the restriction.If, however, future research shows a definite causal like to chronic fatigue syndrome, prostate cancer or any other illnesses, how many people will the ban have protected ?Hundreds ?Thousands ?

It's hard to quantify, but if the original research was right, about 3% of healthy people could carry XMRV.If 3% of blood recipients get tainted blood, they could then pass XMRV along to their children, sexual partners (according to preliminary transmission studies) and anyone who gets blood any of those people may donate down the road.We don't yet have the full picture of how XMRV is transmitted, so there may be other ways to spread it as well.Pretty soon, you're looking at a whole lot of people who are infected and could have the potential to develop something pretty nasty because of it.

XMRV is only the 3rd retrovirus to be conclusively identified in humans.The first was HIV.The second one, HTLV, is linked to leukemia and lymphoma.So out of 3 known retroviruses, we know 2 can be deadly.So far, XMRV is tentatively tied to 1 potentially fatal disease (prostate cancer) and 1 life-long debilitating illness (chronic fatigue syndrome).To me, it makes sense to keep XMRV from further contaminating the blood supply until we know more about it.

In the U.S., the group that assesses threats to the blood supply is called the AABB.It last met in August -- 2 months before the research linking XMRV to chronic fatigue syndrome was published.A Wall Street Journal article talked to an AABB committee member who said she'd give it a "yellow" threat designation, which is the groups' lowest ranking.

Taking the donation idea a step farther, one of my Twitter friends recently posted this :

"Changed my organ donor status coz didn't think it would be a good idea 2 put organs from someone with CFS into someone else."

Because I don't have chronic fatigue syndrome and research into XMRV in fibromyalgia is too miniscule to even be called preliminary, I'm not to the point of changing my organ-donor status.If I had chronic fatigue syndrome, though, I'd have to give it some serious thought.I certainly don't want to inflict illness upon anyone, especially when their health has already taken a serious beat-down.

What do you think ?Do you think it's too early to worry about it, or should we err on the side of caution ?Would you give blood or donate your organs, knowing about the possible XMRV connection to your illness ?

A sample of patients with chronic fatigue syndrome was recruited to assess coping strategies and illness duration.

It was hypothesized that adaptive coping strategies would be higher among those with longer illness duration.

Those in the longer illness duration group reported higher use of active coping, positive reframing, planning and acceptance and lower use of behavioral disengagement than those in the shorter illness duration group. No significant differences were found between the two illness duration groups for physical impairment or symptom severity, but the long duration group revealed a lower percentage of participants who were working than the short duration group.

These findings suggest that individuals with longer or shorter duration of the illness have differences in coping styles but not differences in physical impairment or symptom severity.

WASHINGTON - Studies confirm that Gulf War veterans suffer disproportionately from post-traumatic stress disorder and other psychiatric illnesses as well as vague symptoms often classified as Gulf War Syndrome, a panel of experts reported on Friday.

The Institute of Medicine panel said better studies are needed to characterize a clear pattern of distress and other symptoms among veterans of the conflicts in the Gulf region that started in 1990 and continue today.

"It is clear that a significant portion of the soldiers deployed to the Gulf War have experienced troubling constellations of symptoms that are difficult to categorize," said Stephen Hauser, chairman of the department of neurology at the University of California, San Francisco.

The committee declined to say that there was any such thing as Gulf War Syndrome but did note many veterans had "multisymptom illness."

"Unfortunately, symptoms that cannot be easily quantified are sometimes incorrectly dismissed as insignificant and receive inadequate attention and funding by the medical and scientific establishment," Hauser added in a statement.

"Veterans who continue to suffer from these symptoms deserve the very best that modern science and medicine can offer to speed the development of effective treatments, cures and - we hope – prevention."

Hauser and the rest of the panel reviewed 400 studies in-depth for their report and concluded that in many cases there was tantalizing evidence, but just not enough data to back it up.

Bowel, sleep disturbances

They found many reports of "seemingly related symptoms, including persistent fatigue, chronic fatigue syndrome, irritable bowel syndrome, memory problems, headache, bodily pains, disturbances of sleep, as well as other physical and emotional problems."

But doctors struggle to categorize as they have no known cause, no diagnostic biomarkers and no way to find traces in tissue.

There is also clear evidence of "multisymptom illness" among U.S., British and Australian veterans but not enough evidence to show what may have caused it.

"It is beyond dispute, however, that the prevalence of symptoms such as headaches, joint pain and difficulty concentrating, is higher in veterans deployed to the Gulf War theater than the others," the report reads.

The experts, including epidemiologists who study patterns of disease, neurologists and psychiatrists, found limited but suggestive evidence that Gulf War veterans have higher rates of amyotrophic lateral sclerosis, also called ALS or Lou Gehrig's disease - a crippling, progressive and fatal nerve disease.

An open study of the efficacy and adverse effects of moclobemide in patients with the chronic fatigue syndromeWhite, P.D. & Cleary, K.J. (1997), Department of Psychological Medicine, St Bartholomew's and the Royal London Medical School, London - International Clinical Psychopharmacology, 12, 47-52Cfr. : http://cat.inist.fr/?aModele=afficheN&cpsidt=2661461

Barriers to healthcare utilization in fatiguing illness - A population-based study in GeorgiaLin JM, Brimmer DJ, Boneva RS, Jones JF, Reeves WC, Chronic Viral Diseases Branch, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA : dwe3@cdc.gov - BMC Health Serv Res. 2009 Jan 20;9:13 - PMID: 19154587Background - The purpose of this study was to determine the prevalence of barriers to healthcare utilization in persons with fatiguing illness and describe its association with socio-demographics, the number of health conditions, and frequency of healthcare utilization. Furthermore, we sought to identify what types of barriers interfered with healthcare utilization and why they occurred. Methods - In a cross-sectional population-based survey, 780 subjects, 112 of them with chronic fatigue syndrome (CFS), completed a healthcare utilization questionnaire. Text analysis was used to create the emerging themes from verbatim responses regarding barriers to healthcare utilization. Multiple logistic regression was performed to examine the association between barriers to healthcare utilization and other factors. Results - Forty percent of subjects reported at least one barrier to healthcare utilization. Of 112 subjects with CFS, 55% reported at least one barrier to healthcare utilization. Fatiguing status, reported duration of fatigue, insurance and BMI were significant risk factors for barriers to healthcare utilization. After adjusting for socio-demographics, medication use, the number of health problems and frequency of healthcare utilization, fatiguing status remained significantly associated with barriers to healthcare utilization. Subjects with CFS were nearly 4 times more likely to forego needed healthcare during the preceding year than non-fatigued subjects while those with insufficient fatigue (ISF) were nearly 3 times more likely.Three domains emerged from text analysis on barriers to healthcare utilization : 1) accessibility; 2) knowledge-attitudes-beliefs (KABs); and, 3) healthcare system. CFS and reported duration of fatigue were significantly associated with each of these domains. Persons with CFS reported high levels of healthcare utilization barriers for each domain : accessibility (34%), healthcare system (25%) and KABs (19%). In further examination of barrier domains to healthcare utilization, compared to non-fatigued persons adjusted ORs for CFS having "accessibility", "KAB" and "Healthcare System" barrier domains decreased by 40%, 30% and 19%, respectively. Conclusion - Barriers to healthcare utilization pose a significant problem in persons with fatiguing illnesses. Study results suggested two-fold implications: a symptom-targeted model focusing on symptoms associated with fatigue; and an interactive model requiring efforts from patients and providers to improve interactions between them by reducing barriers in accessibility, KABs and healthcare system.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/19154587?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed

Chronic Fatigue Syndrome - A Biological ApproachPatrick Englebienne & Kenny De Meirleir – CRC, February 27, 2002 (1 edition) – ISBN-10 : 0849310466 – ISBN-13 : 978-0849310461 Chronic Fatigue Syndrome (CFS) is a complex, debilitating disorder, yet few current scientific biomedical books are available on the subject. The nonspecific symptoms, lack of diagnostic tests and uncertainty as to the cause or causes of CFS make the disease that much more baffling. 'Chronic Fatigue Syndrome - A Biological Approach' represents a monumental step in the journey to a unified understanding of CFS and establishes a scientific basis for treatment.The book provides a rare treatise on current state of the art with respect to the worldwide scientifically documented basis of CFS and acknowledges the many as yet undiscovered or undefined pathogenic mechanisms involved in the production of symptoms. The authors, reflecting their clinical and basic research backgrounds, outline future research imperatives and direct clinicians toward appropriate diagnostic and therapeutic strategies.Because of the multifactorial aspects of the disease, the book addresses various fields of the biomedical sciences, such as protein biochemistry, virology and pharmacology. Many recent, biological discoveries help us better understand the physiology of this disease and improve the specificity of its diagnosis by laboratory tests. This book summarizes these advances and discusses insights that support CFS as a distinct and specific physical disease. Overall, 'Chronic Fatigue Syndrome - A Biological Approach' provides a firm foundation understanding of CFS, opening the way for better diagnosis and design of new therapies Cfr. : http://www.amazon.com/Chronic-Fatigue-Syndrome-Biological-Approach/dp/0849310466

Chronic fatigue syndrome - A working case definitionHolmes GP, Kaplan JE, Gantz NM, Komaroff AL, Schonberger LB, Straus SE, Jones JF, Dubois RE, Cunningham-Rundles C, Pahwa S et al., Division of Viral Diseases, Centers for Disease Control, Atlanta, Georgia - Ann Intern Med. 1988 Mar;108(3):387-9 - PMID: 2829679The chronic Epstein-Barr virus syndrome is a poorly defined symptom complex characterized primarily by chronic or recurrent debilitating fatigue and various combinations of other symptoms, including sore throat, lymph node pain and tenderness, headache, myalgia and arthralgias. Although the syndrome has received recent attention and has been diagnosed in many patients, the chronic Epstein-Barr virus syndrome has not been defined consistently. Despite the name of the syndrome, both the diagnostic value of Epstein-Barr virus serologic tests and the proposed causal relationship between Epstein-Barr virus infection and patients who have been diagnosed with the chronic Epstein-Barr virus syndrome remain doubtful. We propose a new name for the chronic Epstein-Barr virus syndrome--the chronic fatigue syndrome--that more accurately describes this symptom complex as a syndrome of unknown cause characterized primarily by chronic fatigue. We also present a working definition for the chronic fatigue syndrome designed to improve the comparability and reproducibility of clinical research and epidemiologic studies and to provide a rational basis for evaluating patients who have chronic fatigue of undetermined cause.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/2829679

Chronic fatigue syndrome - Aetiology, diagnosis and treatmentAvellaneda Fernández A, Pérez Martín A, Izquierdo Martínez M, Arruti Bustillo M, Barbado Hernández FJ, de la Cruz Labrado J, Díaz-Delgado Peñas R, Gutiérrez Rivas E, Palacín Delgado C, Rivera Redondo J, Ramón Giménez JR, Carlos III Health Institute, Sinesio Delgado, n degrees 6, 28029, Madrid, Spanish Society of Primary Care Physicians, Narváez, 15 1 degrees Izda, 28009, Madrid, Spain : alfavel@gmail.com - BMC Psychiatry. 2009 Oct 23;9 Suppl 1:S1 - PMID: 19857242Chronic fatigue syndrome is characterised by intense fatigue, with duration of over six months and associated to other related symptoms. The latter include asthenia and easily induced tiredness that is not recovered after a night's sleep. The fatigue becomes so severe that it forces a 50% reduction in daily activities. Given its unknown aetiology, different hypotheses have been considered to explain the origin of the condition (from immunological disorders to the presence of post-traumatic oxidative stress), although there are no conclusive diagnostic tests. Diagnosis is established through the exclusion of other diseases causing fatigue. This syndrome is rare in childhood and adolescence, although the fatigue symptom per se is quite common in paediatric patients. Currently, no curative treatment exists for patients with chronic fatigue syndrome. The therapeutic approach to this syndrome requires a combination of different therapeutic modalities. The specific characteristics of the symptomatology of patients with chronic fatigue require a rapid adaptation of the educational, healthcare and social systems to prevent the problems derived from current systems. Such patients require multidisciplinary management due to the multiple and different issues affecting them. This document was realized by one of the Interdisciplinary Work Groups from the Institute for Rare Diseases and its aim is to point out the main social and care needs for people affected with Chronic Fatigue Syndrome. For this, it includes not only the view of representatives for different scientific societies, but also the patient associations view, because they know the true history of their social and sanitary needs. In an interdisciplinary approach, this work also reviews the principal scientific, medical, socio-sanitary and psychological aspects of Chronic Fatigue Syndrome.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/19857242?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_PMC&linkpos=1&log$=citedinpmcreviews&logdbfrom=pubmed

Chronic fatigue syndrome – The need for subtypesJason LA, Corradi K, Torres-Harding S, Taylor RR, King C - DePaul University, Chicago, Illinois 60614, USA : ljason@depaul.edu - Neuropsychol Rev. 2005 Mar;15(1):29-58 - PMID: 15929497Chronic fatigue syndrome (CFS) is an important condition confronting patients, clinicians and researchers. This article provides information concerning the need for appropriate diagnosis of CFS subtypes. We first review findings suggesting that CFS is best conceptualized as a separate diagnostic entity rather than as part of a unitary model of functional somatic distress. Next, research involving the case definitions of CFS is reviewed. Findings suggest that whether a broad or more conservative case definition is employed and whether clinic or community samples are recruited, these decisions will have a major influence in the types of patients selected. Review of further findings suggests that subtyping individuals with CFS on sociodemographic, functional disability, viral, immune, neuroendocrine, neurology, autonomic and genetic biomarkers can provide clarification for researchers and clinicians who encounter CFS' characteristically confusing heterogeneous symptom profiles.Treatment studies that incorporate subtypes might be particularly helpful in better understanding the pathophysiology of CFS. This review suggests that there is a need for greater diagnostic clarity and this might be accomplished by subgroups that integrate multiple variables including those in cognitive, emotional, and biological domains.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15929497

Cognitive behaviour therapy for chronic fatigue syndrome in adultsPrice JR, Mitchell E, Tidy E, Hunot V, Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford, UK, OX3 7JX : jonathan.price@psych.ox.ac.uk - Cochrane Database Syst Rev. 2008 Jul 16;(3):CD001027 - PMID: 18646067This article is an update of 'Cognitive behaviour therapy for adults with chronic fatigue syndrome' (Price JR, Couper J, Department of Psychiatry, University of Oxford, The Warneford Hospital, Oxford, UK, OX3 7JX : jonathan.price@psych.ox.ac.uk - Cochrane Database Syst Rev. 2000;(2):CD001027) at : http://www.ncbi.nlm.nih.gov/pubmed/10796733?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractBackground - Chronic fatigue syndrome (CFS) is a common, debilitating and serious health problem. Cognitive behaviour therapy (CBT) may help to alleviate the symptoms of CFS. Objectives - To examine the effectiveness and acceptability of CBT for CFS, alone and in combination with other interventions, compared with usual care and other interventions. Search strategy - CCDANCTR-Studies and CCDANCTR-References were searched on 28/3/2008. We conducted supplementary searches of other bibliographic databases. We searched reference lists of retrieved articles and contacted trial authors and experts in the field for information on ongoing/completed trials. Selection criteria - Randomised controlled trials involving adults with a primary diagnosis of CFS, assigned to a CBT condition compared with usual care or another intervention, alone or in combination. Data collection and analysis - Data on patients, interventions and outcomes were extracted by two review authors independently and risk of bias was assessed for each study. The primary outcome was reduction in fatigue severity, based on a continuous measure of symptom reduction, using the standardised mean difference (SMD) or a dichotomous measure of clinical response, using odds ratios (OR), with 95% confidence intervals (CI). Main results - Fifteen studies (1043 CFS participants) were included in the review. When comparing CBT with usual care (six studies, 373 participants), the difference in fatigue mean scores at post-treatment was highly significant in favour of CBT (SMD -0.39, 95% CI -0.60 to -0.19), with 40% of CBT participants (four studies, 371 participants) showing clinical response in contrast with 26% in usual care (OR 0.47, 95% CI 0.29 to 0.76). Findings at follow-up were inconsistent. For CBT versus other psychological therapies, comprising relaxation, counselling and education/support (four studies, 313 participants), the difference in fatigue mean scores at post-treatment favoured CBT (SMD -0.43, 95% CI -0.65 to -0.20). Findings at follow-up were heterogeneous and inconsistent. Only two studies compared CBT against other interventions and one study compared CBT in combination with other interventions against usual care. Authors' conclusions - CBT is effective in reducing the symptoms of fatigue at post-treatment compared with usual care and may be more effective in reducing fatigue symptoms compared with other psychological therapies. The evidence base at follow-up is limited to a small group of studies with inconsistent findings. There is a lack of evidence on the comparative effectiveness of CBT alone or in combination with other treatments and further studies are required to inform the development of effective treatment programmes for people with CFS.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/18646067?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=4&log$=relatedreviews&logdbfrom=pubmedAlso read the comment on this article :CBT reduces fatigue in adults with chronic fatigue syndrome but effects at follow-up unclear (review)Santhouse AM, South London and Maudsley NHS Foundation Trust, London, UK - Evid Based Ment Health. 2009 Feb;12(1):16 - PMID: 19176775 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/19176775?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

Cognitive behavioural therapy in chronic fatigue syndrome - A randomised controlled trial of an outpatient group programmeO'Dowd H, Gladwell P, Rogers CA, Hollinghurst S, Gregory A, Pain Management Centre, Frenchay Hospital, Bristol, UK - Health Technol Assess. 2006 Oct;10(37):iii-iv, ix-x, 1-121 - PMID: 17014748Objectives - To test the hypothesis that group cognitive behavioural therapy (CBT) will produce an effective and cost-effective management strategy for patients in primary care with chronic fatigue syndrome/myalgic encephalopathy (CFS/ME).Design - A double-blind, randomised controlled trial was adopted with three arms.Outcomes were assessed at baseline and 6 and 12 months after first assessment and results were analysed on an intention-to-treat basis.Setting - A health psychology department for the management of chronic illness in a general hospital in Bristol, UK. Participants - Adults with a diagnosis of CFS/ME referred by their GP. Interventions - The three interventions were group CBT incorporating graded activity scheduling, education and support group (EAS) and standard medical care (SMC). Outcome measures - The primary outcome measure was the Short Form with 36 Items (SF-36) physical and mental health summary scales. Other outcome measures included the Chalder fatigue scale, Hospital Anxiety and Depression Scale, General Health Questionnaire, physical function (shuttles walked, walking speed and perceived fatigue), health utilities index and cognitive function (mood, recall and reaction times). Results - A total of 153 patients were recruited to the trial and 52 were randomised to receive CBT, 50 to EAS and 51 to SMC. Twelve patients failed to attend for the 12-month follow-up and 19 patients attended one follow-up, but not both. The sample was found to be representative of the patient group and the characteristics of the three groups were similar at baseline. Three outcome measures, SF-36 mental health score, Chalder fatigue scale and walking speed, showed statistically significant differences between the groups. Patients in the CBT group had significantly higher mental health scores [difference +4.35, 95% confidence interval (CI) +0.72 to +7.97, p = 0.019], less fatigue (difference -2.61, 95% CI -4.92 to -0.30, p = 0.027) and were able to walk faster (difference +2.83 shuttles, 95% CI +1.12 to +5.53, p = 0.0013) than patients in the SMC group. CBT patients also walked faster and were less fatigued than those randomised to EAS (walking speed : difference +1.77, 95% CI +0.025 to +3.51, p = 0.047; fatigue : difference -3.16, 95% CI -5.59 to -0.74, p = 0.011). Overall, no other statistically significant difference across the groups was found, although for many measures a trend towards an improved outcome with CBT was seen. Except for walking speed, which, on average, increased by +0.87 shuttles (95% CI +0.09 to +1.65, p = 0.029) between the 6- and 12-month follow-ups, the scores were similar at 6 and 12 months. At baseline, 30% of patients had an SF-36 physical score within the normal range and 52% had an SF-36 mental health score in the normal range. At 12 months, the physical score was in the normal range for 46% of the CBT group, 26% of the EAS group and 44% of SMC patients. For mental health score the percentages were CBT 74%, EAS 67% and SMC 70%. Of the CBT group, 32% showed at least a 15% increase in physical function and 64% achieved a similar improvement in their mental health. For the EAS and SMC groups, this improvement in physical and mental health was achieved for 40 and 60% (EAS) and 49 and 53% (SMC), respectively. The cost-effectiveness of the intervention proved very difficult to assess and did not yield reliable conclusions. Conclusions - Group CBT did not achieve the expected change in the primary outcome measure as a significant number did not achieve scores within the normal range post-intervention. The treatment did not return a significant number of subjects to within the normal range on this domain; however, significant improvements were evident in some areas. Group CBT was effective in treating symptoms of fatigue, mood and physical fitness in CFS/ME. It was found to be as effective as trials using individual therapy in these domains. However, it did not bring about improvement in cognitive function or quality of life. There was also evidence of improvement in the EAS group, which indicates that there is limited value in the non-specific effects of therapy. Further research is needed to develop better outcome measures, assessments of the broader costs of the illness and a clearer picture of the characteristics best fitted to this type of intervention.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/17014748?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed

Comorbidity of fibromyalgia and psychiatric disordersBuskila D, Cohen H, Department of Medicine H, Soroka Medical Center, POB 151, Beer Sheva 84101, Israel : dbuskila@bgumail.bgu.ac.il - Curr Pain Headache Rep. 2007 Oct;11(5):333-8 - PMID: 17894922 There are mounting data supporting comorbidity of fibromyalgia syndrome (FMS) and psychiatric conditions. These include depression, panic disorders, anxiety and post-traumatic stress disorder (PTSD). The nature of the relationship between depression and FMS is not fully understood and it was hypothesized that chronic pain causes depression or vice versa and that chronic pain syndromes are variants of depression. A link between PTSD symptoms and FMS has been reported and both conditions share similar symptomatology and pathogenetic mechanisms. Assessment of comorbid psychiatric disorders in FMS patients has clinical implications because treatment in these patients should focus both on physical and emotional dimensions of dysfunction.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/17894922

Complementary and alternative medical therapy utilization by people with chronic fatiguing illnesses in the United StatesJones JF, Maloney EM, Boneva RS, Jones AB, Reeves WC - Division of Viral and Rickettsial Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA : jaj9@cdc.gov - BMC Complement Altern Med. 2007 Apr 25;7:12 - PMID: 17459162Background - Chronic fatiguing illnesses, including chronic fatigue syndrome (CFS), pose a diagnostic and therapeutic challenge. Previous clinical reports addressed the utilization of health care provided to patients with CFS by a variety of practitioners with other than allopathic training, but did not examine the spectrum of complementary and alternative medicine (CAM) therapies used. This study was designed to measure CAM therapy use by persons with fatiguing illnesses in the United States population. Methods - During a random-digit dialing survey to estimate the prevalence of CFS-like illness in urban and rural populations from different geographic regions of the United States, we queried the utilization of CAM including manipulation or body-based therapies, alternative medical systems, mind-body, biologically-based and energy modalities. Results - Four hundred forty fatigued and 444 non-fatigued persons from 2,728 households completed screening. Fatigued subjects included 53 persons with prolonged fatigue, 338 with chronic fatigue and 49 with CFS-like illness. Mind-body therapy (primarily personal prayer and prayer by others) was the most frequently used CAM across all groups. Among women, there was a significant trend of increasing overall CAM use across all subgroups (p-trend = 0.003). All categories of CAM use were associated with significantly poorer physical health scores and all but one (alternative medicine systems) were associated with significantly poorer mental health scores. People with CFS-like illness were significantly more likely to use body-based therapy (chiropractic and massage) than non-fatigued participants (OR = 2.52, CI = 1.32, 4.82). Use of body-based therapies increased significantly in a linear trend across subgroups of non-fatigued, prolonged fatigued, chronic fatigued and CFS-like subjects (p-trend = 0.002).People with chronic fatigue were also significantly more likely to use body-based therapy (OR = 1.52, CI = 1.07, 2.16) and mind-body (excluding prayer) therapy than non-fatigued participants (OR = 1.73, CI = 1.20 - 2.48). Conclusion - Utilization of CAM was common in fatiguing illnesses and was largely accounted for by the presence of underlying conditions and poor physical and mental health.Compared to non-fatigued persons, those with CFS-like illness or chronic fatigue were most likely to use body-based and mind-body therapies. These observations have important implications for provider education programs and development of intervention strategies for CFS.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/17459162?dopt=Abstract

Death of a lifestyle – The effects of social support and healthcare support on the quality of life of persons with fibromyalgia and/or chronic fatigue syndromeSchoofs, N., Bambini, D., Ronning, P., Bielak, E. & Woehl, J. (2004) - Orthop.Nurs., 23, 364-374Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15682879

Development of a simple screening tool for common mental disorders in general practiceHickie IB, Davenport TA, Hadzi-Pavlovic D, Koschera A, Naismith SL, Scott EM, Wilhelm KA, School of Psychiatry, University of New South Wales, Sydney : ian.hickie@beyondblue.org.au - Med J Aust. 2001 Jul 16;175 Suppl:S10-7 - PMID: 11556430Objective - To develop and validate a self-report screening tool for common mental disorders.Design and setting - Sequential development and validation studies in three cohorts of patients in general practice and one cohort of patients in a specialist psychiatry clinic.Participants - 1585 patients in general practice examined cross-sectionally and longitudinally; 46515 patients attending 386 general practitioners nationwide; 364 patients participating in a longitudinal study of psychiatric disorders in general practice; and 522 patients attending a specialist psychiatry clinic. Main outcome measures - Performance of the 12 items from the 34-item SPHERE questionnaire against DSM-III-R and DSM-IV diagnoses of psychiatric disorder, self-reported Brief Disability Questionnaire findings, GPs' ratings of patients' needs for psychological care and degree of risk resulting from mental disorder and patients' and GPs' reports of reasons for presentation. Results - Six somatic and six psychological questions identify two levels (and three types) of mental disorder: patients reporting both characteristic psychological and somatic symptoms (Level 1, Type 1) and patients reporting either psychological symptoms (Level 2, Type 2) or somatic symptoms (Level 2, Type 3). This classification system predicts disability ratings (Level 1, 8.2 "days out of role in the last month" and Level 2, 4.1 and 5.4 "days out of role in the last month" for Types 2 and 3, respectively), rates of lifetime psychiatric diagnoses (Level 1, 63% and Level 2, 59% and 48%, respectively), both patients' and GPs' report of reasons for presentation and doctors' ratings of risk as a result of mental disorder. There are important and differing sociodemographic correlates for the three types of mental disorders. Conclusion - A classification system based on the 12 items from the 34-item SPHERE questionnaire can be used to identify common mental disorders. This system has acceptable validity and reliability and is suited specifically for general practice settings.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11556430?dopt=AbstractAlso read the comment on this article :Mental distress or disorder ?Harris MF, Penrose-Wall J, School of Community Medicine, University of New South Wales, Sydney - Med J Aust. 2001 Jul 16;175 Suppl:S6-7 - PMID: 11556439Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11556439?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

Diagnose and be damned - Management of CFS in children is not contentious [letter]Wessely S - BMJ 2000; 320: 1004

Effect of a self-management program on patients with chronic diseaseLorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M, Stanford University School of Medicine, Calif, USA : lorig@stanford.edu - Eff Clin Pract. 2001 Nov-Dec;4(6):256-62 - PMID: 11769298Context : For patients with chronic disease, there is growing interest in "self-management" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases. Objective - To evaluate outcomes of a chronic disease self-management program in a real-world" setting. Study design - Before-after cohort study. Patients and setting - Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study, 489 had complete baseline and follow-up data. Intervention - The Chronic Disease Self-Management Program is a 7-week, small-group intervention attended by people with different chronic conditions. It is taught largely by peer instructors from a highly structured manual. The program is based on self-efficacy theory and emphasizes problem solving, decision making and confidence building. Main outcome measures - Health behavior, self-efficacy (confidence in ability to deal with health problems), health status and health care utilization, assessed at baseline and at 12 months by self-administered questionnaires. Results - At 1 year, participants in the program experienced statistically significant improvements in health behaviors (exercise, cognitive symptom management and communication with physicians), self-efficacy and health status (fatigue, shortness of breath, pain, role function, depression and health distress) and had fewer visits to the emergency department (ED) (0.4 visits in the 6 months prior to baseline, compared with 0.3 in the 6 months prior to follow-up; P = 0.05). There were slightly fewer outpatient visits to physicians and fewer days in hospital, but the differences were not statistically significant. Results were of about the same magnitude as those observed in a previous randomized, controlled trial. Program costs were estimated to be about $200 per participant. Conclusions - We replicated the results of our previous clinical trial of a chronic disease self-management program in a "real-world" setting. One year after exposure to the program, most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11769298

Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndromeDemitrack MA, Crofford LJ, Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, Indiana 46285, USA - Ann N Y Acad Sci. 1998 May 1;840:684-97 - PMID: 9629295Chronic fatigue syndrome (CFS) is characterized by profound fatigue and an array of diffuse somatic symptoms. Our group has established that impaired activation of the hypothalamic-pituitary-adrenal (HPA) axis is an essential neuroendocrine feature of this condition. The relevance of this finding to the pathophysiology of CFS is supported by the observation that the onset and course of this illness is excerbated by physical and emotional stressors. It is also notable that this HPA dysregulation differs from that seen in melancholic depression, but shares features with other clinical syndromes (e.g., fibromyalgia). How the HPA axis dysfunction develops is unclear, though recent work suggests disturbances in serotonergic neurotransmission and alterations in the activity of AVP, an important co-secretagogue that, along with CRH, influences HPA axis function. In order to provide a more refined view of the nature of the HPA dusturbance in patients with CFS, we have studied the detailed, pulsatile characteristics of the HPA axis in a group of patients meeting the 1994 CDC case criteria for CFS. Results of that work are consistent with the view that patients with CFS have a reduction of HPA axis activity due, in part, to impaired central nervous system drive. These observations provide an important clue to the development of more effective treatment to this disabling condition.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/9629295?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=2&log$=relatedreviews&logdbfrom=pubmed

Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization - A randomized trialLorig KR, Sobel DS, Stewart AL, Brown BW Jr, Bandura A, Ritter P, Gonzalez VM, Laurent DD, Holman HR, Stanford University School of Medicine, California, USA : lorig@leland.Stanford.edu - Med Care. 1999 Jan;37(1):5-14 - PMID: 10413387Objectives - This study evaluated the effectiveness (changes in health behaviors, health status and health service utilization) of a self-management program for chronic disease designed for use with a heterogeneous group of chronic disease patients. It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities. Methods - The study was a six-month randomized, controlled trial at community-based sites comparing treatment subjects with wait-list control subjects. Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease, lung disease, stroke or arthritis. Health behaviors, health status and health service utilization, as determined by mailed, self-administered questionnaires, were measured. Results - Treatment subjects, when compared with control subjects, demonstrated improvements at 6 months in weekly minutes of exercise, frequency of cognitive symptom management, communication with physicians, self-reported health, health distress, fatigue, disability and social/role activities limitations. They also had fewer hospitalizations and days in the hospital. No differences were found in pain/physical discomfort, shortness of breath or psychological well-being. Conclusions - An intervention designed specifically to meet the needs of a heterogeneous group of chronic disease patients, including those with comorbid conditions, was feasible and beneficial beyond usual care in terms of improved health behaviors and health status. It also resulted in fewer hospitalizations and days of hospitalization.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/10413387

Exploring the perspectives of people whose lives have been affected by depressionMcNair BG, Highet NJ, Hickie IB, Davenport TA – Beyondblue - The national depression initiative, Melbourne, VIC, Australia - Med J Aust. 2002 May 20;176 Suppl:S69-76 - PMID: 12065001Objectives - To describe the experiences of people whose lives have been affected by depression. Design, setting and particiapants - Thematic review of data collected from 21 community meetings (1529 people, providing 911 evaluation forms) and nine focus groups (69 individuals) held nationally and written feedback and website-based interactions with 'Beyondblue (the national depression initiative)' between April and December 2001. Main oucome measures - Barriers to social participation experienced by people whose lives have been affected by depression and their interactions with the healthcare system. Results - The key theme was the experience of stigma, which was evident in healthcare settings and in barriers to social participation, particularly regarding employment.Inadequacies of primary care and specialist treatment systems were highlighted.Particular emphasis was placed on limited access to high-quality primary care and non-pharmacological care. The stigmatising attitudes of many healthcare providers were notable. Within society, lack of access to knowledge and self-care or mutual support services was evident. Lack of support both from and for people in caring roles was also emphasised. Conclusions - People with depression are subject to many of the same attitudes, inadequate healthcare and social barriers reported by people with psychotic disorders. Consumers and carers prioritise certain notions of illness, recovery and quality of healthcare and expect healthcare providers to respond to these concerns.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12065001?dopt=Abstract -&- http://www.mja.com.au/public/issues/176_10_200502/mcn10080_fm.html

Follow up of 200 young people with CFS - Relationship of functional outcomes to symptom patterns and psychological featuresRowe KS, Rowe KJ - Proceedings of the 5th International Conference of the American Association of Chronic Fatigue Syndrome, Seattle Washington Jan 24-26, 2001: A92

Growth hormone as concomitant treatment in severe fibromyalgia associated with low IGF-1 serum levels - A pilot studyCuatrecasas G, Riudavets C, Güell MA, Nadal A, Servicio de Endocrinología y Nutrición, Centro Médico Teknon, Vilana 12, E-08022 Barcelona, Spain : endocrinologia@teknon.es - BMC Musculoskelet Disord. 2007 Nov 30;8:119 - PMID: 18053120 – Trial registration : NCT00497562 (ClinicalTrials.gov) Background - There is evidence of functional growth hormone (GH) deficiency, expressed by means of low insulin-like growth factor 1 (IGF-1) serum levels, in a subset of fibromyalgia patients. The efficacy of GH versus placebo has been previously suggested in this population. We investigated the efficacy and safety of low dose GH as an adjunct to standard therapy in the treatment of severe, prolonged and well-treated fibromyalgia patients with low IGF-1 levels. Methods - Twenty-four patients were enrolled in a randomized, open-label, best available care-controlled study. Patients were randomly assigned to receive either 0.0125 mg/kg/d of GH subcutaneously (titrated depending on IGF-1) added to standard therapy or standard therapy alone during one year. The number of tender points, the Fibromyalgia Impact Questionnaire (FIQ) and the EuroQol 5D (EQ-5D), including a Quality of Life visual analogic scale (EQ-VAS) were assessed at different time-points. Results - At the end of the study, the GH group showed a 60% reduction in the mean number of tender points (pairs) compared to the control group (p < 0.05; 3.25 +/- 0.8 vs. 8.25 +/- 0.9). Similar improvements were observed in FIQ score (p < 0.05) and EQ-VAS scale (p < 0.001). There was a prompt response to GH administration, with most patients showing improvement within the first months in most of the outcomes. The concomitant administration of GH and standard therapy was well tolerated and no patients discontinued the study due to adverse events. Conclusion - The present findings indicate the advantage of adding a daily GH dose to the standard therapy in a subset of severe fibromyalgia patients with low IGF-1 serum levels.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/18053120?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_PMC&linkpos=3&log$=citedinpmcarticles&logdbfrom=pubmed

Guidelines for the development and implementation of clinical practice guidelinesNational Health and Medical Research Council - Canberra: NHMRC, Oct 1995

Hypothalamic-pituitary-adrenal axis reactivity in chronic fatigue syndrome and health under psychological, physiological and pharmacological stimulationGaab J, Hüster D, Peisen R, Engert V, Heitz V, Schad T, Schürmeyer TH, Ehlert U, Center for Psychobiological and Psychosomatic Research, University of Trier, Trier, Germany : jgaab@klipsy.unizh.ch - Psychosom Med. 2002 Nov-Dec;64(6):951-62 - PMID: 12461200Objectives - Subtle alterations of the hypothalamic-pituitary-adrenal (HPA) axis in chronic fatigue syndrome (CFS) have been proposed as a shared pathway linking numerous etiological and perpetuating processes with symptoms and observed physiological abnormalities. Because the HPA axis is involved in the adaptive responses to stress and CFS patients experience a worsening of symptoms after physical and psychological stress, we tested HPA axis functioning with three centrally acting stress tests.Methods - We used two procedures mimicking real-life stressors and compared them with a standardized pharmacological neuroendocrine challenge test. CFS patients were compared with healthy control subjects regarding their cardiovascular and endocrine reactivity in a psychosocial stress test and a standardized exercise test and their endocrine response in the insulin tolerance test (ITT).Results - Controlling for possible confounding variables, we found significantly lower ACTH response levels in the psychosocial stress test and the exercise test and significantly lower ACTH responses in the ITT, with no differences in plasma total cortisol responses.Also, salivary-free cortisol responses did not differ between the groups in the psychosocial stress test and the exercise test but were significantly higher for the CFS patients in the ITT.In all tests CFS patients had significantly reduced baseline ACTH levels.Conclusions - These results suggest that CFS patients are capable of mounting a sufficient cortisol response under different types of stress but that on a central level subtle dysregulations of the HPA axis exist.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12461200?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=4&log$=relatedarticles&logdbfrom=pubmed

Mental health literacy" - A survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatmentJorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P, NHMRC Social Psychiatry Research Unit, Australian National University, Canberra, ACT : Anthony.Jorm@anu.edu.au - Med J Aust. 1997 Feb 17;166(4):182-6 - PMID: 9066546Objectives - To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments ("mental health literacy"). Design - A cross-sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia. Participants - A representative national sample of 2031 individuals aged 18-74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette. Results - Most of the participants recognised the presence of some sort of mental disorder : 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%). When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so.Corresponding data for the schizophrenia vignette were : counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%). Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems). Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics. Conclusion - If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised.Further, public understanding of psychiatric treatments can be considerably improved.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/9066546?dopt=Abstract

Neurasthenia - Prevalence, disability and health care characteristics in the Australian communityHickie I, Davenport T, Issakidis C, Andrews G, School of Psychiatry, University of New South Wales, Sydney, Australia : ian.hickie@beyondblue.org.au - Br J Psychiatry. 2002 Jul;181:56-61 - PMID: 12091264Background - Neurasthenia imposes a high burden on primary medical health care systems in all societies.Aims - To determine the prevalence of ICD-10 neurasthenia and associated comorbidity, disability and health care utilisation.Method - Utilisation of a national sample of Australian households previously surveyed using the Composite International Diagnostic Interview and other measures.Results - Prolonged and excessive fatigue was reported by 1465 people (13.29% of the sample). Of these, one in nine people meet current ICD-10 criteria for neurasthenia. Comorbidity was associated with affective, anxiety and physical disorders. People with neurasthenia alone (<0.5% of the population) were less disabled and used less services than those with comorbid disorders.Conclusions - Fatigue is frequent in the Australian community and is common in people attending general practice. Neurasthenia is disabling and demanding of services largely because of its comorbidity with other mental and physical disorders. Until a remedy for persistent fatigue is provided, doctors should take an active psychological approach to treatment.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12091264?dopt=AbstractAlso read the comment on this article :Chronic fatigue syndrome or neurasthenia ?Bailly L - Br J Psychiatry. 2002 Oct;181:350-1 - PMID: 12356666Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12356666?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

Neuroendocrine perturbations in fibromyalgia and chronic fatigue syndromeNeeck G, Crofford LJ, Department of Rheumatology, University of Giessen, Bad Nauheim, Germany : gunther.neeck@kerckhoff.med.uni-giessen.de - Rheum Dis Clin North Am. 2000 Nov;26(4):989-1002 - PMID: 11084955A large body of data from a number of different laboratories worldwide has demonstrated a general tendency for reduced adrenocortical responsiveness in CFS. It is still not clear if this is secondary to CNS abnormalities leading to decreased activity of CRH- or AVP-producing hypothalamic neurons. Primary hypofunction of the CRH neurons has been described on the basis of genetic and environmental influences. Other pathways could secondarily influence HPA axis activity, however. For example, serotonergic and noradrenergic input acts to stimulate HPA axis activity.Deficient serotonergic activity in CFS has been suggested by some of the studies as reviewed here. In addition, hypofunction of sympathetic nervous system function has been described and could contribute to abnormalities of central components of the HPA axis. One could interpret the clinical trial of glucocorticoid replacement in patients with CFS as confirmation of adrenal insufficiency if one were convinced of a positive therapeutic effect.If patient symptoms were related to impaired activation of central components of the axis, replacing glucocorticoids would merely exacerbate symptoms caused by enhanced negative feedback. Further study of specific components of the HPA axis should ultimately clarify the reproducible abnormalities associated with a clinical picture of CFS. In contrast to CFS, the results of the different hormonal axes in FMS support the assumption that the distortion of the hormonal pattern observed can be attributed to hyperactivity of CRH neurons. This hyperactivity may be driven and sustained by stress exerted by chronic pain originating in the musculoskeletal system or by an alteration of the CNS mechanism of nociception. The elevated activity of CRH neurons also seems to cause alteration of the set point of other hormonal axes. In addition to its control of the adrenal hormones, CRH stimulates somatostatin secretion at the hypothalamic level, which, in turn, causes inhibition of growth hormone and thyroid-stimulating hormone at the pituitary level. The suppression of gonadal function may also be attributed to elevated CRH because of its ability to inhibit hypothalamic luteinizing hormone-releasing hormone release; however, a remote effect on the ovary by the inhibition of follicle-stimulating hormone-stimulated estrogen production must also be considered. Serotonin (5-HT) precursors such as tryptophan (5-HTP), drugs that release 5-HT or drugs that act directly on 5-HT receptors stimulate the HPA axis, indicating a stimulatory effect of serotonergic input on HPA axis function. Hyperfunction of the HPA axis could also reflect an elevated serotonergic tonus in the CNS of FMS patients. The authors conclude that the observed pattern of hormonal deviations in patients with FMS is a CNS adjustment to chronic pain and stress, constitutes a specific entity of FMS and is primarily evoked by activated CRH neurons.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11084955?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=3&log$=relatedreviews&logdbfrom=pubmed

Promoting evidence-based non-drug interventions - Time for a non-pharmacopoeia ?Paul P Glasziou - Med J Aust 2009; 191 (2): 52-53In 2004, the Journal published a randomised controlled trial of graded exercise for chronic fatigue syndrome (CFS).As with several similar trials, this trial found that graded exercise was an effective intervention. But what is graded exercise ? In response to numerous emails from both doctors and CFS patients who wanted further details of the exercise program, the authors of the study published a second article that provided the additional “how to” details and addressed different scenarios.I now keep the pdf file of this second article on my general practice computer to give to and discuss with, CFS patients. The difficulties in accessing information on this simple, non-drug intervention are in stark contrast to the helpful tools available for prescribing pharmaceuticals : formularies, prescription pads and pharmacies.Cfr. : http://www.mja.com.au/public/issues/191_02_200709/gla10407_fm.html

Psychoneuroendocrinological contributions to the etiology of depression, posttraumatic stress disorder and stress-related bodily disorders - The role of the hypothalamus-pituitary-adrenal axisEhlert U, Gaab J, Heinrichs M, Department of Clinical Psychology, University of Zurich, Zurichbergstrasse 43, CH-8044, Zurich, Switzerland : ehlertu@klipsy.unizh.ch - Biol Psychol. 2001 Jul-Aug;57(1-3):141-52 - PMID: 11454437Following the assumption that stressors play an important part in the etiology and maintenance of psychiatric disorders, it is necessary to evaluate parameters reflecting stress-related physiological reactions. Results from these examinations may help to deepen the insight into the etiology of psychiatric disorders and to elucidate diagnostic uncertainties. One of the best-known stress-related endocrine reactions is the hormonal release of the hypothalamic-pituitary-adrenal (HPA) axis. Dysregulations of this axis are associated with several psychiatric disorders. Profound hyperactivity of the HPA-axis has been found in melancholic depression, alcoholism and eating disorders. In contrast, posttraumatic stress disorder, stress-related bodily disorders like idiopathic pain syndromes and chronic fatigue syndrome seem to be associated with diminished HPA activity (lowered activity of the adrenal gland). Hypotheses referring to (a) the psychophysiological meaning and (b) the development of these alterations are discussed.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11454437?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&logdbfrom=pubmed

Public beliefs about the helpfulness of interventions for depression - Effects on actions taken when experiencing anxiety and depression symptomsJorm AF, Medway J, Christensen H, Korten AE, Jacomb PA, Rodgers B, Centre for Mental Health Research, Australian National University, Canberra : Anthony.Jorm@anu.edu.au - Aust N Z J Psychiatry. 2000 Aug;34(4):619-26 - PMID: 10954393Objective - Previous research has shown that the public have different beliefs to mental health professionals about the helpfulness of interventions for mental disorders. However, it is not known whether the public's beliefs actually influence their behaviour when they develop psychiatric symptoms. Method - A postal survey of 3,109 Australian adults was used to assess beliefs about the helpfulness of a broad range of interventions for depression, as well as respondents' current level of anxiety and depression symptoms and any history of treated depression. A follow-up survey of 422 persons who had a high level of symptoms at baseline was conducted 6 months later. These people were asked which interventions they had used to reduce their symptoms. An analysis was carried out to see whether beliefs and other factors at baseline predicted subsequent use of interventions. Results - There were some major discrepancies between the ranking of interventions as likely to be helpful and the ranking of how frequently they were actually used. Interventions involving mental health professionals were often rated as likely to be helpful, but were rarely used in practice. Other simple, cheap and readily available interventions were used the most frequently, but were not the most likely to be rated as helpful. The most consistent predictors across all interventions used were gender, history of treatment, current symptoms and belief in a particular intervention. Of particular interest was the finding that beliefs in the helpfulness of antidepressants predicted their use. However, beliefs were not predictors of use for all interventions. Conclusions - Beliefs about the helpfulness of an intervention did not always predict actual use of that intervention, although beliefs did predict use of antidepressants. Therefore, campaigns that change public beliefs about effective treatments may also influence actual use of treatments. Interventions preferred by professionals are not frequently used at present. Most people with anxiety and depression symptoms rely primarily on simple self-help interventions, the effectiveness of which has been little researched.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/10954393?dopt=Abstract

Quality of attention in chronic fatigue syndrome - Subjective reports of everyday attention and cognitive difficulty and performance on tasks of focused attentionRay C, Phillips L, Weir WR - Br J Clin Psychol. 1993 Sep;32 (:357–364Patients with chronic fatigue syndrome (also known as post-viral fatigue syndrome or myalgic encephalomyelitis) commonly report cognitive difficulties concerning attention, concentration and memory. In this study, patients were compared with matched controls on two questionnaires which assess subjective difficulties with attention and general cognitive functioning and on two tasks requiring focused attention. Patients reported significantly greater difficulty with attention on the Everyday Attention Questionnaire and more cognitive symptoms on the Profile of Fatigue-Related Symptoms.The objective tests did not clearly indicate a deficit in patients' focused attention; patients tended to perform less well on the Embedded Figures Test and the Stroop Colour-Word Interference Test, but these differences were not significant. There was, however, evidence of psychomotor retardation, with patients having longer response times for word reading and colour naming in the Stroop test. Difficulties in interpreting findings for both subjective and objective cognitive measures are discussed.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/8251968

Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndromePowell P, Bentall RP, Nye FJ, Edwards RHT - BMJ 2001; 322: 1-5Objective - To assess the efficacy of an educational intervention explaining symptoms to encourage graded exercise in patients with chronic fatigue syndrome.Design - Randomised controlled trial.Setting - Chronic fatigue clinic and infectious diseases outpatient clinic.Subject - 148 consecutively referred patients fulfilling Oxford criteria for chronic fatigue syndrome.Interventions - Patients randomised to the control group received standardised medical care.Patients randomised to intervention received two individual treatment sessions and two telephone follow up calls, supported by a comprehensive educational pack, describing the role of disrupted physiological regulation in fatigue symptoms and encouraging home based graded exercise. The minimum intervention group had no further treatment, but the telephone intervention group received an additional seven follow up calls and the maximum intervention group an additional seven face to face sessions over four months.Main outcome measure - A score of >/=25 or an increase of >/=10 on the SF-36 physical functioning subscale (range 10 to 30) 12 months after randomisation.Results - 21 patients dropped out, mainly from the intervention groups. Intention to treat analysis showed 79 (69%) of patients in the intervention groups achieved a satisfactory outcome in physical functioning compared with two (6%) of controls, who received standardised medical care (P<0.0001). Similar improvements were observed in fatigue, sleep, disability and mood. No significant differences were found between the three intervention groups.Conclusions - Treatment incorporating evidence based physiologicalexplanations for symptoms was effective in encouraging self managed graded exercise. This resulted in substantial improvement compared with standardised medical care.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11179154Also read the comment on this article :Patient education to encourage graded exercise in chronic fatigue syndrome - Trial has too many shortcomingsChaudhuri A - BMJ. 2001 Jun 23;322(7301):1545-6 - PMID: 11439997Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11439997?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for Gulf War related health concernsEngel CC Jr, Liu X, McCarthy BD et al., Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington, DC, USA : cengel@pobox.com - Psychosom Med 2000;62:739–45Objectives - Studies of the relationship of posttraumatic stress disorder (PTSD) to physical symptoms in war veterans consistently show a positive relationship. However, traumatic experiences causing PTSD may correlate with other war exposures and medical illnesses potentially accounting for those symptoms.Methods - We analyzed data obtained from 21,244 Gulf War veterans seeking care for war-related health concerns to assess the relationship of PTSD to physical symptoms independent of environmental exposure reports and medical illness. At assessment, veterans provided demographic information and checklists of 15 common physical symptoms and 20 wartime environmental exposures. Up to seven ICD-9 provider diagnoses were ranked in order of estimated clinical significance. The relationship of provider-diagnosed PTSD to various physical symptoms and to the total symptom count was then determined in bivariate and multivariate analyses.Results - Veterans diagnosed with PTSD endorsed an average of 6.7 (SD = 3.9) physical symptoms, those with a non-PTSD psychological condition endorsed 5.3 (3.5), those with medical illness endorsed 4.3 (3.4) and a group diagnosed as "healthy" endorsed 1.2 (2.2).For every symptom, the proportion of veterans reporting the symptom was highest in those with PTSD, second highest in those with any psychological condition, third highest in those with any medical illness and lowest in those labeled as healthy. The PTSD-symptom count relationship was independent of demographic characteristics, veteran-reported environmental exposures and comorbid medical conditions, even when symptoms overlapping with those of PTSD were excluded.Conclusions - PTSD diminishes the general health perceptions of care-seeking Gulf War veterans. Clinicians should carefully consider PTSD when evaluating Gulf War veterans with vague, multiple or medically unexplained physical symptoms.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11138991

Report of a workshop on the epidemiology, natural history and pathogenesis of chronic fatigue syndrome in adolescentsMarshall GS - J Pediatr 1999; 134: 395-405

Rheumatic fibromyalgia - Psychiatric features (article in Spanish)Sarró Alvarez S, Centro de Salud Mental. Martí i Julià. Sta. Coloma de Gramanet. Barcelona. Spain - Actas Esp Psiquiatr. 2002 Nov-Dec;30(6):392-6 - PMID: 12487950Rheumatic fibromyalgia, also known as fibrositis or myofascial pain, is a common syndrome whose diagnoses, founded mainly on physical examination, usually delays due to symptom unspecificity, amount of complementary tests requested and intercourse with psychiatric disorders. Psychyatrists and psychologists get often involved in fibromyalgia treatment. Its proper knowledge prevents not only physicians and patients' psychological discourage but also development of depression and mental health expenses, as well as allows designing a treatment plan according to the main symptoms which may offer improvement chances to fibromyalgia patients. This article intends to offer an up-to-date and complete information about this entity, focused on psychiatric aspects, to better identify and manage such a puzzling disease.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12487950

Role of impaired lower-limb venous innervation in the pathogenesis of the chronic fatigue syndromeStreeten DH, Department of Medicine, SUNY Upstate Medical University, Syracuse, New York 13210, USA - Am J Med Sci. 2001 Mar;321(3):163-7 - PMID: 11269790Background - In patients with acute orthostatic hypotension, there is excessive pooling of blood in the legs, which may result from the strikingly subnormal compliance that is demonstrable in the pedal veins during norepinephrine infusion. The common occurrence of delayed orthostatic hypotension and/or tachycardia in the chronic fatigue syndrome (CFS) led to the present studies of foot vein compliance in CFS patients with a linear variable differential transformer. Methods - Seven patients with CFS were compared with 7 age- and gender matched healthy control subjects in their blood pressure, heart-rate and plasma norepinephrine responses to prolonged standing and in measurements of their foot vein contractile responses to intravenous norepinephrine infusions with the linear variable differential transformer. Results - Excessive, delayed (usually after 10 min) orthostatic reductions in systolic and diastolic blood pressure (P < 0.01) and inconsistently excessive increases in heart rate were found in the CFS patients, in whom venous compliance in response to infused norepinephrine was significantly reduced (P < 0.05).Conclusions - In these patients with CFS, delayed orthostatic hypotension was clearly demonstrable and, as in previously reported patients with orthostatic hypotension of acute onset, this was associated with reduced pedal vein compliance during norepinephrine infusion, implying impaired sympathetic innervation of foot veins. The rapid symptomatic improvement demonstrated in previous studies of CFS patients during correction of orthostatic venous pooling by inflation of military antishock trousers (MAST) to 35 mm Hg may suggest that excessive lower body venous pooling, perhaps by reducing cerebral perfusion, is involved in the orthostatic component of fatigue in these patients.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11269790?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

Screening for prolonged fatigue syndromes - Validation of the SOFA scaleHadzi-Pavlovic D, Hickie IB, Wilson AJ, Davenport TA, Lloyd AR, Wakefield D, Mood Disorders Unit, Prince of Wales Hospital, Randwick, NSW, Australia : D.Hadzi-Pavlovic@unsw.edu.au - Soc Psychiatry Psychiatr Epidemiol. 2000 Oct;35(10):471-9 - PMID: 11127722Background - The identification of syndromes characterised by persistent and disabling mental and/or physical fatigue is of renewed interest in psychiatric epidemiology. This report details the development of two specific instruments : the SOFA/CFS for identification of patients with chronic fatigue syndrome (CFS) in specialist clinics and the SOFA/GP for identification of prolonged fatigue syndromes (PFS) in community and primary care settings. Methods - Patients with clinical diagnoses of CFS (n = 770) and consecutive attenders at primary care (n = 1593) completed various self-report questionnaires to assess severity of current fatigue-related symptoms and other common somatic and psychological symptoms.Quality receiver operating characteristic curves were used to derive appropriate cut-off scores for each of the instruments. Comparisons with other self-report measures of anxiety, depression and somatic distress are noted. Various multivariate statistical modelling techniques [latent class analysis (LCA), longitudinal LCA] were utilised to define the key features of PFS and describe its longitudinal characteristics. Results - The SOFA/CFS instrument performs well in specialist samples likely to contain a high proportion of patients with CFS disorders. Cut-off scores of either 1/2 or 2/3 can be used, depending on whether the investigators wish to preferentially emphasise false-negatives or false-positives. Patients from these settings can be thought of as consisting not only of those with a large number of unexplained medical symptoms, but also those with rather specific musculoskeletal and pain syndromes. The SOFA/GP instrument has potential cut-off scores of 1/2 or 2/3, with the latter preferred as it actively excludes all non-PFS cases (sensitivity = 81%, specificity = 100%). Patients with these syndromes in the community represent broader sets of underlying classes, with the emergence of not only musculoskeletal and multisymptomatic disorders, but also persons characterised by significant cognitive subjective impairment. Twelve-month longitudinal analyses of the primary care sample indicated that the underlying class structure was preserved over time. Comparisons with other measures of psychopathology indicated the relative independence of these constructs from conventional notions of anxiety and depression. Conclusions - The SOFA/GP instrument (which is considerably modified from the SOFA/CFS in terms of anchor points for severity and chronicity) is preferred for screening in primary care and community settings. Patients with PFS and CFS present a range of psychopathology that differs in its underlying structure, cross-sectionally and longitudinally, from coventional notions of anxiety and depression.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11127722

Somatization and depression in fibromyalgia syndromeKirmayer LJ, Robbins JM, Kapusta MA, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada - Am J Psychiatry. 1988 Aug;145(8):950-4 - PMID: 3164984Psychiatric diagnoses, self-reports of symptoms and illness behavior of 20 fibromyalgia patients and 23 rheumatoid arthritis patients were compared. The fibromyalgia patients were not significantly more likely than the arthritis patients to report depressive symptoms or to receive a lifetime psychiatric diagnosis of major depression.These results do not support the contention that fibromyalgia is a form of somatized depression.Fibromyalgia patients, however, reported significantly more somatic symptoms of obscure origin and exhibited a pattern of reporting more somatic symptoms, multiple surgical procedures and help seeking that may reflect a process of somatization rather than a discrete psychiatric disorder.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/3164984

Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factorsGiesecke T, Williams DA, Harris RE, Cupps TR, Tian X, Tian TX, Gracely RH, Clauw DJ, University of Michigan, Ann Arbor, USA - Arthritis Rheum. 2003 Oct;48(10):2916-22 - PMID: 14558098Objective - Although the American College of Rheumatology (ACR) criteria for fibromyalgia are used to identify individuals with both widespread pain and tenderness, individuals who meet these criteria are not a homogeneous group. Patients differ in their accompanying clinical symptoms, as well as in the relative contributions of biologic, psychological and cognitive factors to their symptom expression.Therefore, it seems useful to identify subsets of fibromyalgia patients on the basis of which of these factors are present. Previous attempts at identifying subsets have been based solely on psychological and cognitive features. In this study, we attempt to identify patient subsets by incorporating these features as well as the degree of hyperalgesia/tenderness, which is a key neurobiologic feature of this illness. Methods - Ninety-seven individuals meeting the ACR criteria for fibromyalgia finished the same battery of self-report and evoked-pain testing. Analyzed variables were obtained from several domains, consisting of 1) mood (evaluated by the Center for Epidemiologic Studies Depression Scale [for depression] and the State-Trait Personality Inventory [for symptoms of trait-related anxiety]), 2) cognition (by the catastrophizing and control of pain subscales of the Coping Strategies Questionnaire) and 3) hyperalgesia/tenderness (by dolorimetry and random pressure-pain applied at suprathreshold values). Cluster analytic procedures were used to distinguish subgroups of fibromyalgia patients based on these domains. Results - Three clusters best fit the data. Multivariate analysis of variance (ANOVA) confirmed that each variable was differentiated by the cluster solution (Wilks' lambda [degrees of freedom 6,89] = 0.123, P < 0.0001), with univariate ANOVAs also indicating significant differences (all P < 0.05). One subgroup of patients (n = 50) was characterized by moderate mood ratings, moderate levels of catastrophizing and perceived control over pain and low levels of tenderness. A second subgroup (n = 31) displayed significantly elevated values on the mood assessments, the highest values on the catastrophizing subscale, the lowest values for perceived control over pain and high levels of tenderness. The third group (n = 16) had normal mood ratings, very low levels of catastrophizing and the highest level of perceived control over pain, but these subjects showed extreme tenderness on evoked-pain testing. Conclusion - These data help support the clinical impression that there are distinct subgroups of patients with fibromyalgia. There appears to be a group of fibromyalgia patients who exhibit extreme tenderness but lack any associated psychological/cognitive factors, an intermediate group who display moderate tenderness and have normal mood and a group in whom mood and cognitive factors may be significantly influencing the symptom report.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/14558098Also read the comment on this article :No justification for publication of study on subgrouping of fibromyalgia patients - Comment on the article by Giesecke et al.Ehrlich GE - Arthritis Rheum. 2004 Aug;50(8):2716; author reply 2716-7 - PMID: 15334497Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15334497?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

Symptom occurrence in persons with chronic fatigue syndromeJason LA, Torres-Harding SR, Carrico AW, Taylor RR, DePaul University, Center for Community Research, 990 West Fullerton Road, Chicago, IL 60614, USA : Ljason@depaul.edu - Biol Psychol. 2002 Feb;59(1):15-27 - PMID: 11790441This investigation compared differences in the occurrence of symptoms in participants with CFS, melancholic depression and no fatigue (controls). The following Fukuda et al. [Ann. Intern. Med. 121 (1994) 953] criteria symptoms differentiated the CFS group from controls, but did not differentiate the melancholic depression group from controls : headaches, lymph node pain, sore throat, joint pain and muscle pain. In addition, participants with CFS uniquely differed from controls in the occurrence of muscle weakness at multiple sites as well as in the occurrence of various cardiopulmonary, neurological and other symptoms not currently included in the current case definition. Implications of these findings are discussed.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11790441

The connection between chronic fatigue syndrome and neurally mediated hypotensionWilke WS, Fouad-Tarazi FM, Cash JM, Calabrese LH, Department of Rheumatic and Immunologic Disease, Cleveland Clinic Foundation, OH 44195, USA - Cleve Clin J Med. 1998 May;65(5):261-6 - PMID: 9599909Research from several groups of investigators indicates that some patients with chronic fatigue syndrome have abnormal vasovagal or vasodepressor responses to upright posture. If confirmed, these findings may explain some of the symptoms of chronic fatigue syndrome. There is also speculation that neurally mediated hypotension may be present in fibromyalgia. This article discusses the original research in this area, the results of follow-up studies and the current approach to treating patients with chronic fatigue syndrome in whom neurally mediated hypotension is suspected.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/9599909

The economic impact of chronic fatigue syndromeReynolds KJ, Vernon SD, Bouchery E, Reeves WC, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, U.S.A. : wcr1@cdc.gov - Cost Eff Resour Alloc. 2004 Jun 21;2(1):4 - PMID: 15210053Background - Chronic fatigue syndrome (CFS) is a chronic incapacitating illness that affects between 400,000 and 800,000 Americans. Despite the disabling nature of this illness, scant research has addressed the economic impact of CFS either on those affected or on the national economy. Methods - We used microsimulation methods to analyze data from a surveillance study of CFS in Wichita, Kansas and derive estimates of productivity losses due to CFS. Results - We estimated a 37% decline in household productivity and a 54% reduction in labor force productivity among people with CFS. The annual total value of lost productivity in the United States was $9.1 billion, which represents about $20,000 per person with CFS or approximately one-half of the household and labor force productivity of the average person with this syndrome. Conclusion - Lost productivity due to CFS was substantial both on an individual basis and relative to national estimates for other major illnesses. CFS resulted in a national productivity loss comparable to such losses from diseases of the digestive, immune and nervous systems and from skin disorders. The extent of the burden indicates that continued research to determine the cause and potential therapies for CFS could provide substantial benefit both for individual patients and for the nation.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15210053

The epidemiology of anxiety disorders - Prevalence and societal costsLépine JP, Assistance Publique Hôpitaux de Paris, Service de Psychiatrie, Hôpital Fernand Widal, Paris, France : jean-pierre.lepine@lrb.aphop-paris.fr - J Clin Psychiatry. 2002;63 Suppl 14:4-8 -PMID: 12562112Anxiety disorders are the most prevalent of psychiatric disorders, yet less than 30% of individuals who suffer from anxiety disorders seek treatment. Prevalence of anxiety disorders is difficult to pinpoint since even small changes in diagnostic criteria, interview tools or study methodology affect results. Analyses of the largest prevalence studies of psychiatric illnesses in the United States find that anxiety disorders afflict 15.7 million people in the United States each year and 30 million people in the United States at some point in their lives. Currently, the European Study of Epidemiology of Mental Disorders and the World Health Organization World Mental Health 2000 studies are underway. These studies, which share a similar methodology, will facilitate future worldwide comparisons of the prevalence of anxiety disorders. Anxiety disorders impose high individual and social burden, tend to be chronic and can be as disabling as somatic disorders. Compared with those who have other psychiatric disorders, people with anxiety disorders are high care utilizers who present to general practitioners more frequently than to psychiatric professionals, placing a strain upon the health care system. The economic costs of anxiety disorders include psychiatric, nonpsychiatric and emergency care; hospitalization; prescription drugs; reduced productivity; absenteeism from work; and suicide.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12562112?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=4&log$=relatedreviews&logdbfrom=pubmed

The family response questionnaire - A new scale to assess the responses of family members to people with chronic fatigue syndromeCordingley L, Wearden A, Appleby L, Fisher L - J Psychosom Res 2001; 51: 417-424

The fibromyalgia syndrome as a manifestation of neuroticism ?P. Netter & J. Hennig, Department of Psychology, University of Giessen, Germany : petra.netter@psychol-uni-giessen.de - Zeitschrift fur Rheumatologie 1998;57 Suppl 2():105-8After elucidating the components and theory of neuroticism (N) as well as of psychosomatic complaints and their relationships to personality dimensions and to psychosomatic diseases, comparisons are performed between patients suffering from fibromyalgia syndrome (FMS) or related pain diseases with healthy subjects scoring high on personality dimensions related to neuroticism. FMS and pain patients score high on depression, anxiety and experience of stress although questionnaire scores on depression are higher in subjects not exhibiting somatic features of the disease. High subjective pain sensitivity and low thresholds for pain perception are also common features in high N subjects and FMS patients. On the endocrinological level cortisol responses to challenge tests with CRH as well as prolactin responses to TRH are higher in FMS patients than in high N healthy subjects indicating an endocrinological difference. A common feature, however, is the lack of adaptability in the two groups, since neurotics are in particular characterized by a low capacity to shift their behavior from one state to the other (waking-sleeping, working-relaxing), to re-adapt to baseline levels after endocrinological or physiological stress responses or to adjust to conditions of shift work.This is reflected by chronobiological disturbances in FMS patients and could also explain their maintainance of pain perception, because they are incapable of correcting conditioned pain-producing muscle tension.Cfr. : http://www.websciences.org/cftemplate/NAPS/archives/indiv.cfm?ID=19991043

The HPA axis and the genesis of chronic fatigue syndromeCleare AJ, Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, The Institute of Psychiatry, London, SE5 8AF, UK : a.cleare@iop.kcl.ac.uk - Trends Endocrinol Metab. 2004 Mar;15(2):55-9 - PMID: 15036250Many studies of patients with long-standing chronic fatigue syndrome (CFS) have found alterations to the hypothalamo-pituitary-adrenal (HPA) axis, including mild hypocortisolism, heightened negative feedback and blunted responses to challenge. However, recent prospective studies of high-risk cohorts suggest that there are no HPA axis changes present during the early stages of the genesis of fatiguing illnesses. Moreover, HPA axis changes can be reversed by modifying behavioural features of the illness, such as inactivity, deconditioning and sleep disturbance. Nevertheless, raising levels of cortisol pharmacologically can temporarily alleviate symptoms of fatigue. This article presents the case that there is no specific change to the HPA axis in CFS and that the observed changes are of multifactorial aetiology, with some factors occurring as a consequence of the illness. Nevertheless, the HPA axis might play a role in exacerbating or perpetuating symptoms late on in the course of the illness.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15036250

The hypothalamic-pituitary-adrenal stress axis in fibromyalgia and chronic fatigue syndromeCrofford LJ, Division of Rheumatology, University of Michigan, Ann Arbor 48109-0680, USA : crofford@umich.edu - Z Rheumatol. 1998;57 Suppl 2:67-71 - PMID: 10025087HPA axis abnormalities in FM, CFS and other stress-related disorders must be placed in a broad clinical context. We know that interventions providing symptomatic improvement in patients with FM and CFS can directly or indirectly affect the HPA axis. These interventions include exercise, tricyclic anti-depressants and serotonin reuptake inhibitors. There is little direct information as to how the specific HPA axis perturbations seen in FM can be related to the major symptomatic manifestations of pain, fatigue, sleep disturbance and psychological distress. Since many of these somatic and psychological symptoms are present in other syndromes that exhibit HPA axis disturbances, it seems reasonable to suggest that there may be some relationship between basal and dynamic function of the HPA axis and clinical manifestations of FM and CFS.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/10025087?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=1&log$=relatedreviews&logdbfrom=pubmed

The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndromeTanriverdi F, Karaca Z, Unluhizarci K, Kelestimur F, Department of Endocrinology, Medical School, Erciyes University, Kayseri, Turkey - Stress. 2007 Mar;10(1):13-25 - PMID: 17454963 The hypothalamo-pituitary-adrenal (HPA) axis plays a major role in the regulation of responses to stress. Human stress-related disorders such as chronic fatigue syndrome (CFS), fibromyalgia syndrome (FMS), chronic pelvic pain and post-traumatic stress disorder are characterized by alterations in HPA axis activity. However, the role of the HPA axis alterations in these stress-related disorders is not clear.Most studies have shown that the HPA axis is underactive in the stress-related disorders, but contradictory results have also been reported, which may be due to the patients selected for the study, the methods used for the investigation of the HPA axis, the stage of the syndrome when the tests have been done and the interpretation of the results. There is no structural abnormality in the endocrine organs which comprise the HPA axis, thus it seems that hypocortisolemia found in the patients with stress-related disorder is functional. It may be also an adaptive response of the body to chronic stress. In this review, tests used in the assessment of HPA axis function and the HPA axis alterations found in CFS and FMS are discussed in detail.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/17454963

The mental health of patients with a chief complaint of chronic fatigue - A prospective evaluation and follow-upManu P, Matthews DA, Lane TJ, Division of General Medicine, University of Connecticut Health Center, Farmington 06032 - Arch Intern Med. 1988 Oct;148(10):2213-7 - PMID: 3178379To determine the psychiatric morbidity of patients complaining of chronic fatigue, we undertook a prospective evaluation of 100 adults (65 women and 35 men; mean age, 41 years; and mean duration of chronic fatigue, 13 years). The study was conducted in an internal medicine outpatient clinic. In addition to a comprehensive medical evaluation, the patients were administered the 260-item Diagnostic Interview Schedule, a highly structured instrument that enabled the physician-interviewer to make accurate psychiatric diagnoses. A thorough follow-up examination was given an average of 8.4 months later. Sixty-six patients had one or more psychiatric disorders that were considered a major cause of their chronic fatigue (mood disorder, 47 patients; somatization disorder, 15 patients; and anxiety disorder, nine patients). Five patients had medical conditions that were considered a major cause of their fatigue. The complaint of chronic fatigue remained unexplained in 31 patients. In this prospective study, two thirds of cases of chronic fatigue appeared to be caused by psychiatric disorders. A thorough evaluation of the mental health of patients complaining of chronic fatigue could therefore provide pharmacologic and psychotherapeutic approaches and avoid unnecessary and costly medical investigations and therapies.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/3178379Also read the comment on this article :Chronic fatigue - Psyche or sleep ?[No authors listed] - Arch Intern Med. 1990 May;150(5):1116, 1118, 1121 - PMID: 2331192Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/2331192?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

The neuroendocrinology of chronic fatigue syndromeCleare AJ, Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, The Institute of Psychiatry, London SE5 8AZ, United Kingdom : a.cleare@iop.kcl.ac.uk - Endocr Rev. 2003 Apr;24(2):236-52 - PMID: 12700181Chronic fatigue syndrome (CFS) is a common and disabling problem; although most likely of biopsychosocial origin, the nature of the pathophysiological components remains unclear.There has been a wealth of interest in the endocrinology of this condition, which will be reviewed in this article. Most studied has been the hypothalamic-pituitary-adrenal (HPA) axis; although the quality of many studies is poor, the overall balance of evidence points to reduced cortisol output in at least some patients, with some evidence that this is linked to symptom production or persistence. There is evidence for heightened negative feedback and glucocorticoid receptor function and for impaired ACTH and cortisol responses to a variety of challenges. However, there is no evidence for a specific or uniform dysfunction of the HPA axis. Given the many factors that may impinge on the HPA axis in CFS, such as inactivity, sleep disturbance, psychiatric comorbidity, medication and ongoing stress, it seems likely that HPA axis disturbance is heterogeneous and of multifactorial etiology in CFS. Studies assessing GH, dehydroepiandrostenedione and its sulfate, melatonin, leptin and neuroendocrine-monoamine interactions are also reviewed. There is some evidence from these studies to suggest alterations of dehydroepiandrostenedione sulfate function and abnormal serotonin function in CFS, but whether these changes are of functional importance remains unclear. To obtain a clearer assessment of the etiological and pathophysiological relevance of endocrine changes in CFS, it is suggested that more prospective cohort studies be undertaken in groups at high risk for CFS, that patients with CFS are followed up into recovery and that multidimensional assessments are undertaken to unravel the influence of the various confounding factors on the observed endocrine changes in CFS.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12700181

The role of psychiatric disorders in fibromyalgiaMcBeth J, Silman Ajm Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK . john.mcbeth@fsl.ser.man.ac.uk - Curr Rheumatol Rep. 2001 Apr;3(2):157-64 - PMID: 11286672The cardinal features of fibromyalgia are chronic widespread pain in the presence of widespread tenderness as measured by multiple tender points. Despite extensive investigations, the etiology of this syndrome remains unclear. Increased rates of psychiatric disorders, particularly depressive, anxiety and somatoform disorders, are apparent in clinic populations. Epidemiologic evidence suggests that this is also true for community subjects. Depression, generalized psychological distress and other psychological factors have been shown to be associated with the onset and persistence of fibromyalgia symptoms. However, the bodily processes through which such factors may lead to the onset of fibromyalgia are unclear. Recent investigations have demonstrated altered stress system responsiveness, most notably the hypothalamic-pituitary-adrenal stress axis, in patients with fibromyalgia. These findings and one promising avenue for investigating the interaction between psychological and biological factors in the onset of chronic pain syndromes including fibromyalgia, are discussed.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11286672

The roles of orthostatic hypotension, orthostatic tachycardia, and subnormal erythrocyte volume in the pathogenesis of the chronic fatigue syndromeStreeten DH, Thomas D, Bell DS, Department of Medicine, State University of New York Health Science Center, Syracuse 13210, USA - Am J Med Sci. 2000 Jul;320(1):1-8 - PMID: 10910366Background - Orthostatic hypotension during upright tilt is an important physical disorder in patients with chronic fatigue syndrome. We have tested its occurrence during prolonged standing, whether it is correctable and whether reduced circulating erythrocyte volume is present. Methods - Fifteen patients were randomly selected from a large population of patients with chronic fatigue syndrome, studied and observed for several years (by DSB). Blood pressure (BP) and heart rate (HR) measured with Dinamap every minute for 30 minutes supine and 60 minutes standing were compared with these findings in 15 healthy age- and gender-matched control subjects and later during lower body compression with military antishock trousers (MAST). Plasma catecholamines and circulating erythrocyte and plasma volumes were also measured by isotopic dilution methods. Results - Abnormal findings in the patients included excessive orthostatic reductions in systolic (P < 0.001) and diastolic BP (P < 0.001) and excessive orthostatic tachycardia (P < 0.01), together with presyncopal symptoms in 11 of the 15 patients and in none of the control subjects after standing for 60 min. Lower body compression with the MAST restored all orthostatic measurements to normal and overcame presyncopal symptoms within 10 min. Circulating erythrocyte but not plasma volumes were subnormal in the 12 women (P < 0.01) and plasma norepinephrine concentration rose excessively after standing for 10 min.Conclusion - Delayed orthostatic hypotension and/or tachycardia caused by excessive gravitational venous pooling, which is correctable with external lower-body compression, together with subnormal circulating erythrocyte volume, are very frequent, although not invariably demonstrable, findings in moderate to severe chronic fatigue syndrome. When present, they may be involved in its pathogenesis.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/10910366

The Sickness of WarThomas M. Walshe, MD - Published in Journal Watch Neurology October 6, 2005 (covering Ann Intern Med 2005 Jun 7; 142:881-90)Questionnaire studies aimed at identifying causes of illness in military personnel deployed during the 1991 Gulf War have provided no clear evidence of specific causes...Cfr. : http://neurology.jwatch.org/cgi/content/citation/2005/1006/9

The Structured Clinical Interview for DSM-III-R (SCID) – I. - History, rationale and descriptionSpitzer RL, Williams JB, Gibbon M, First MB, Department of Psychiatry, Columbia University, New York, NY - Arch Gen Psychiatry. 1992 Aug;49(8):624-9 - PMID: 1637252The history, rationale and development of the Structured Clinical Interview for DSM-III-R (SCID) is described. The SCID is a semistructured interview for making the major Axis I DSM-III-R diagnoses. It is administered by a clinician and includes an introductory overview followed by nine modules, seven of which represent the major axis I diagnostic classes. Because of its modular construction, it can be adapted for use in studies in which particular diagnoses are not of interest. Using a decision tree approach, the SCID guides the clinician in testing diagnostic hypotheses as the interview is conducted. The output of the SCID is a record of the presence or absence of each of the disorders being considered, for current episode (past month) and for lifetime occurrence.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/1637252

The Structured Clinical Interview for DSM-III-R (SCID) – II. - Multisite test-retest reliabilityWilliams JB, Gibbon M, First MB, Spitzer RL, Davies M, Borus J, Howes MJ, Kane J, Pope HG Jr, Rounsaville B et al., Department of Psychiatry, Columbia University, New York, NY. - Arch Gen Psychiatry. 1992 Aug;49(8):630-6 - PMID: 1637253A test-retest reliability study of the Structured Clinical Interview for DSM-III-R was conducted on 592 subjects in four patient and two nonpatient sites in this country as well as one patient site in Germany. For most of the major categories, kappa s for current and lifetime diagnoses in the patient samples were above .60, with an overall weighted kappa of .61 for current and .68 for lifetime diagnoses. For the nonpatients, however, agreement was considerably lower, with a mean kappa of .37 for current and .51 for lifetime diagnoses. These values for the patient and nonpatient samples are roughly comparable to those obtained with other structured diagnostic instruments. Sources of diagnostic disagreement, such as inadequate training of interviewers, information variance and low base rates for many disorders, are discussed.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/1637253?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

The use of a symptom "self-report" inventory to evaluate the acceptability and efficacy of a walking program for patients suffering with chronic fatigue syndromeCoutts R, Weatherby R, Davie A - J Psychosom Res 2001; 51: 425-429

Thirteen-year follow-up of children and adolescents with chronic fatigue syndromeBell DS, Jordan K, Robinson M, Primary Care Pediatrics, Lyndonville, New York, USA - Pediatrics. 2001 May;107(5):994-8 - PMID: 11331676Objective - To describe the educational, social, and symptomatic outcome of children and adolescents with chronic fatigue syndrome 13 years after illness onset. Methods - Between January 1984 and December 1987, 46 children and adolescents developed an illness suggestive of chronic fatigue syndrome. Follow-up questionnaires were obtained from 35 participants an average of 13 years after illness onset. Data were obtained concerning subsequent medical diagnoses, amount of school missed, presence and severity of current symptoms and subjective assessment of degree of illness resolution.Results - Of the 35 participants, 24 were female (68.6%) and 11 were male (31.4%). Average age at illness onset was 12.1 years. Eight participants (22.9%) had an acute onset of symptoms, 27 (77.1%) had a gradual onset.No participant received an alternative medical diagnosis that could have explained the symptom complex between illness onset and follow-up. Thirteen participants (37.1%) considered themselves resolved of illness at follow-up; 15 participants (42.9%) considered themselves well but not resolved; 4 (11.4%) considered themselves chronically ill; and 3 (8.6%) considered themselves more ill than during the early years of illness. Correlation with the Medical Outcomes Study Short Form Health Survey was good for current level of symptoms and degree of recovery. Eight participants (22.9%) missed >2 years of school and 5 of these were still ill at follow-up. Amount of school missed correlated with both illness severity at follow-up and perceived social impact of the illness. Conclusions - These data demonstrate the presence of an illness consistent with the current definition of chronic fatigue syndrome. Eighty percent of children and adolescents affected had a satisfactory outcome from their fatiguing illness, although the majority of these participants had mild to moderate persisting symptoms. Twenty percent of participants remain ill with significant symptoms and activity limitation 13 years after illness onset. Chronic fatigue syndrome in children and adolescents may result in persistent somatic symptoms and disability in a minority of those affected.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11331676

Time for Healing - Relaxation for mind and bodyCatherine Regan, Ph.D. - Bull PublishingCatherine Regan, Ph.D., is a clinical psychologist whose work includes a broad range of psychotherapy and behavioral medicine interventions. She lives and works in San Francisco, CA.'Time for Healing' includes two 30-minute relaxation exercises with soft background music and the voice of Catherine Regan. They are meant to release tension, achieve deep muscular relaxation and guide listeners toward heightened self-awareness. Widely used in conjunction with our chronic conditions books. Now available in CD format.Cfr. : http://www.bullpub.com/healing.html

Traditional Chinese Medicine for Chronic Fatigue SyndromeRui Chen1,2, Junji Moriya2, Jun-ichi Yamakawa2, Takashi Takahashi2 and Tsugiyasu Kanda2 - 1Department of Traditional Chinese Medicine, Union Hospital Affiliated to Huazhong University of Science and Technology, Wuhan, China and 2Department of General Medicine, Kanazawa Medical University, Ishikawa, Japan - Evid Based Complement Alternat Med 2008More and more patients have been diagnosed as having chronic fatigue syndrome (CFS) in recent years. Western drug use for this syndrome is often associated with many side-effects and little clinical benefit. As an alternative medicine, traditional Chinese medicine (TCM) has provided some evidences based upon ancient texts and recent studies, not only to offer clinical benefit but also offer insights into their mechanisms of action. It has perceived advantages such as being natural, effective and safe to ameliorate symptoms of CFS such as fatigue, disordered sleep, cognitive handicaps and other complex complaints, although there are some limitations regarding the diagnostic standards and methodology in related clinical or experimental studies. Modern mechanisms of TCM on CFS mainly focus on adjusting immune dysfunction, regulating abnormal activity in the hypothalamic-pituitary-adrenal (HPA) axis and serving as an antioxidant. It is vitally important for the further development to establish standards for ‘zheng’ of CFS, i.e. the different types of CFS pathogenesis in TCM, to perform randomized and controlled trials of TCM on CFS and to make full use of the latest biological, biochemical, molecular and immunological approaches in the experimental design.Cfr. : http://ecam.oxfordjournals.org/cgi/content/full/nen017

Treating depression - The beyondblue guidelines for treating depression in primary care - "Not so much what you do but that you keep doing it"Ellis PM, Smith DA, Beyond blue, the national depression initiative - Department of Psychological Medicine, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington South, New Zealand : ellis@wnmeds.ac.nz - Med J Aust. 2002 May 20;176 Suppl:S77-83 - PMID: 12065002 1/ Most people with depression will be treated in general practice, either by the GP alone or (for more serious depression) in partnership with specialist mental health services.2/ Treatment plans should always be based on thorough assessment, including the type, severity and duration of the depressive episode and any stressors that contributed to the episode.3/ For mild and moderate depression, meta-analysis shows there is little difference in relative effectiveness of treatments and continuation of therapy is more important than initial treatment choice. 4/ The best outcomes are likely when a good therapeutic alliance is formed between a healthcare professional and the patient and adequate treatment is provided over a long enough period. For pharmacological interventions, treatment should continue for : at least one year for a first episode of depression and at least two years for repeated episodes or where there are other risk factors for relapse.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12065002?dopt=AbstractAlso read the comment on this article :How long should drug treatment of depression last ?Fava GA, Ruini C, Tossani E - Med J Aust. 2003 May 19;178(10):526; author reply 526-7 - PMID: 12741948Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12741948?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

Treatment options and patient perspectives in the management of fibromyalgia - Future trendsLawson K, Biomedical Research Centre, Sheffield Hallam University, Faculty of Health and Wellbeing, Sheffield, UK - Neuropsychiatr Dis Treat. 2008 Dec;4(6):1059-71 - PMID: 19337451Fibromyalgia (FM) is a common, complex and difficult to treat chronic widespread pain disorder, which usually requires a multidisciplinary approach using both pharmacological and non-pharmacological (education and exercise) interventions. It is a condition of heightened generalized sensitization to sensory input presenting as a complex of symptoms including pain, sleep dysfunction and fatigue, where the pathophysiology could include dysfunction of the central nervous system pain modulatory systems, dysfunction of the neuroendocrine system and dysautonomia. A cyclic model of the pathophysiological processes is compatible with the interrelationship of primary symptoms and the array of postulated triggers associated with FM. Many of the molecular targets of current and emerging drugs used to treat FM have been focused to the management of discrete symptoms rather than the condition. Recently, drugs (eg, pregabalin, duloxetine, milnacipran, sodium oxybate) have been identified that demonstrate a multidimensional efficacy in this condition. Although the complexity of FM suggests that monotherapy, non-pharmacological or pharmacological, will not adequately address the condition, the outcomes from recent clinical trials are providing important clues for treatment guidelines, improved diagnosis, and condition-focused therapies.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/19337451?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_PMC&linkpos=1&log$=citedinpmcarticles&logdbfrom=pubmed

Unexplained suffering in the aftermath of warAnthony L. Komaroff - Annals 2005 142: 938-939In 1990, military forces from Iraq invaded and occupied Kuwait and massed at the Saudi Arabia border. Early in 1991, an international alliance led by the United States attacked Iraqi forces and rapidly drove them back into Iraq. More than 500 000 U.S. personnel were involved in the Gulf War military action.Approximately 300 were killed and 500 were wounded—remarkably low numbers for a force of that size. But the end of hostilities was not the end of the story. By the end of 1991, many Gulf War veterans felt unwell. They reported various persistent and debilitating symptoms. Both the U.S. Department of Defense and the U.S. Department of Veterans Affairs created registries of ailing combatants from the Gulf War. The most commonly reported symptoms were fatigue, rashes, headache, muscle and joint pain and memory impairment (1, 2). Disability claims mounted. By 2001, nearly 20% of personnel deployed to the Gulf War were receiving some form of disability compensation (3). Was the Gulf War, in fact, associated with an unusual burden of chronic multisymptom reports ? Data from the registries could not answer that question, since the individuals in the registries were self-selected. Therefore, the U.S. Department of Veterans Affairs initiated several large population-based studies. The studies—conducted in the United States (4, 5), the United Kingdom (6, 7), Canada (8), and Denmark (9)—shared certain features .../... Cfr. : http://www.annals.org/content/142/11/938.extract

Unique genetic and environmental determinants of prolonged fatigue - A twin studyHickie I, Kirk K, Martin N, School of Psychiatry, University of New South Wales, Sydney, Australia - Psychol Med. 1999 Mar;29(2):259-68 - PMID: 10218917Background - Prolonged fatigue syndromes have been proposed as prevalent and disabling forms of distress that occur independently of conventional notions of anxiety and depression. Methods - To investigate the genetic and environmental antecedents of common forms of psychological and somatic distress, we measured fatigue, anxiety, depression and psychological distress in 1004 normal adult twin pairs (533 monozygotic (MZ), 471 dizygotic (DZ)) over 50 years of age. Results - Familial aggregation of psychological distress, anxiety and fatigue appeared to be due largely to additive genetic factors (MZ:DZ ratios of 2.12-2.69). The phenotypic correlations between the psychological measures (distress, anxiety and depression) were moderate (0.67-0.79) and higher than that between fatigue and psychological distress (0.38). Multivariate genetic modelling revealed a common genetic factor contributing to the development of all the observed phenotypes (though most strongly for the psychological forms), a second independent genetic factor also influenced anxiety and depression and a third independent genetic factor made a major contribution to fatigue alone. In total, 44% (95% CI 25-60%) of the genetic variance for fatigue was not shared by the other forms of distress. Similarly, the environmental factor determining psychological distress made negligible contributions to fatigue, which was underpinned largely by its own independent environmental factor. Conclusion - This study supports the aetiological independence of prolonged fatigue and, therefore, argues strongly for its inclusion in classification systems in psychiatry.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/10218917

Use of medications by people with chronic fatigue syndrome and healthy persons - A population-based study of fatiguing illness in GeorgiaBoneva RS, Lin JM, Maloney EM, Jones JF, Reeves WC, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA : rboneva@cdc.gov - Health Qual Life Outcomes. 2009 Jul 20;7:67 - PMID: 19619330Background - Chronic fatigue syndrome (CFS) is a debilitating condition of unknown etiology and no definitive pharmacotherapy. Patients are usually prescribed symptomatic treatment or self-medicate. We evaluated prescription and non-prescription drug use among persons with CFS in Georgia and compared it to that in non-fatigued Well controls and also to chronically Unwell individuals not fully meeting criteria for CFS. Methods - A population-based, case-control study. To identify persons with possible CFS-like illness and controls, we conducted a random-digit dialing telephone screening of 19,807 Georgia residents, followed by a detailed telephone interview of 5,630 to identify subjects with CFS-like illness, other chronically Unwell, and Well subjects. All those with CFS-like illness (n = 469), a random sample of chronically Unwell subjects (n = 505) and Well individuals (n = 641) who were age-, sex-, race- and geographically matched to those with CFS-like illness were invited for a clinical evaluation and 783 participated (48% overall response rate). Clinical evaluation identified 113 persons with CFS, 264 Unwell subjects with insufficient symptoms for CFS (named ISF) and 124 Well controls; the remaining 280 subjects had exclusionary medical or psychiatric conditions and 2 subjects could not be classified.Subjects were asked to bring all medications taken in the past 2 weeks to the clinic where a research nurse viewed and recorded the name and the dose of each medication. Results - More than 90% of persons with CFS used at least one drug or supplement within the preceding two weeks. Among users, people with CFS used an average of 5.8 drugs or supplements, compared to 4.1 by ISF and 3.7 by Well controls. Persons with CFS were significantly more likely to use antidepressants, sedatives, muscle relaxants and anti-acids than either Well controls or the ISF group. In addition, persons with CFS were significantly more likely to use pain-relievers, anti-histamines and cold/sinus medications than were Well controls. Conclusion - Medical care providers of patients with chronic fatigue syndrome should be aware of polypharmacy as a problem in such patients and the related potential iatrogenic effects and drug interactions.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/19619330?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed

Variability in diagnostic criteria for chronic fatigue syndrome may result in substantial differences in patterns of symptoms and disabilityLeonard A. Jason, Jena Helgerson & Susan R. Torres-Harding, DePaul University - Adam W. Carrico, University of Miami - Renee R. Taylor, University of Illinois - Evaluation & the Health Professions, Vol. 26, No. 1, 3-22 (2003)Chronic fatigue syndrome (CFS) is an illness that involves severe, prolonged exhaustion as well as neurologic, immunologic and endocrine system pathology. Because the pathogenesis of CFS has yet to be determined, case definitions have relied on clinical observation in classifying signs and symptoms for diagnosis. The current investigation examined differences between CFS as defined by Fukuda and colleagues and a set of criteria that has been stipulated for myalgic encephalomyelitis (ME). Dependent measures included psychiatric comorbidity, symptom frequency, symptom severity and functional impairment. The ME and Fukuda et al. (1994) CFS criteria were compared with a group having chronic fatigue due to psychiatric reasons. Significant differences occurred primarily with neurologic, neuropsychiatric, fatigue/weakness and rheumatological symptoms. These findings suggest that it might be inappropriate to synthesize results from studies of this illness that use different definitions to select study populations.Cfr. : http://ehp.sagepub.com/cgi/content/abstract/26/1/3

What people say about their general practitioners' treatment of anxiety and depressionAndrews G, Carter GL, School of Psychiatry, University of NSW at St Vincent's Hospital, Sydney : gavina@crufad.unsw.edu.au - Med J Aust. 2001 Jul 16;175 Suppl:S48-51 - PMID: 11556437 (erratum in : Med J Aust 2001 Nov 19;175(10):560 & Med J Aust 2002 Jan 21;176(2):69)Objective - To determine from self-report how often people with anxiety and depressive disorders consult GPs and what treatment they receive.Design - The study was derived from the 1997 Australian National Survey of Mental Health and Wellbeing. A probability sample of adults was interviewed to determine how many had which mental disorders, how disabled they were by those disorders and what treatment they had received.Participants - 10641 adults, a 78% response rate.Main outcome measures - Prevalence of anxiety and depressive disorders and related disability; frequency of consultations for a mental problem; treatment received.Results - 13.6% of the population both met criteria for an anxiety or depressive disorder in the 12 months before the survey and, when they suffered from more than one disorder, nominated this as their principal complaint. They reported some disability in 7 of the previous 28 days, and consulted a GP or other health professional 1.4 times in that period. Over half did not seek a consultation for a mental health problem at any time during the year, many because they thought they had no need.Conclusion - Many people who could benefit from treatment for anxiety and depressive disorders are not being reached. If people were registered with a general practice it would be possible for GPs to take a proactive stance that could result in greater benefit to patients at a lower cost to the health system.Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11556437?dopt=AbstractAlso read the comments on this article :- Mental distress or disorder ?Harris MF, Penrose-Wall J, School of Community Medicine, University of New South Wales, Sydney - Med J Aust. 2001 Jul 16;175 Suppl:S6-7 - PMID: 11556439Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11556439?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract- Treating depression - Making it betterEllis PM, Smith DA, Bushnell JA, Wellington School of Medicine and Health Sciences, University of Otago, New Zealand - Med J Aust. 2001 Jul 16;175 Suppl:S8-9 - PMID: 11556440Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11556440?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

When do symptoms become a disease ?Aronowitz RA - Ann Intern Med 2001; 134 Suppl: 803-808When do symptoms become a disease ? Are there rules or norms, currently or in the past, that tell us when a particular collection of largely symptom-based criteria has enough specificity, utility or plausibility to justify the appellation disease ? The history of numerous symptom-based diagnoses in use today suggests partial answers to these questions. The 19th-century shift to understanding ill health as a result of specific diseases, increasingly defined more by signs than symptoms, led to a loss of status for illnesses that possessed little clinical or laboratory specificity. Nevertheless, clinicians then and now have used symptom-based diagnoses. Some of these diagnoses owe their existence as specific diseases to the norms and practices of an older era much different from our own. Others have not only thrived but have resisted plausible redefinition done by using more “objective” criteria. Many strategies, such as response-to-treatment arguments, quantitative methods (for example : factor analysis) and consensus conferences, have been used to find or confer specificity in symptom-based diagnoses. These strategies are problematic and have generally been used after symptom-based diagnoses have been recognized and defined. These historical observations emphasize that although biological and clinical factors have set boundaries for which symptoms might plausibly be linked in a disease concept, social influences have largely determined which symptom clusters have become diseases. Cfr. : http://www.annals.org/content/134/9_Part_2/803.abstract

In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs (observed by a physician), symptoms (reported by the patient), phenomena or characteristics that often occur together, so that the presence of one feature alerts the physician to the presence of the others. In recent decades, the term has been used outside medicine to refer to a combination of phenomena seen in association.

The term 'syndrome' derives from its Greek roots (σύνδρομος) and means literally "run together", as the features do. It is most often used to refer to the set of detectable characteristics when the reason that they occur together (the pathophysiology of the syndrome) has not yet been discovered. A familiar syndrome name often continues to be used even after an underlying cause has been found or when there are a number of different primary causes that all give rise to the same combination of symptoms and signs. Many syndromes are named after the physicians credited with first reporting the association; these are "eponymous" syndromes (cfr. also the list of eponymous diseases, many of which are referred to as "syndromes"). Otherwise, disease features or presumed causes, as well as references to geography, history or poetry, can lend their names to syndromes.

"Subsyndromal" conditions (or "formes fruste") are those which do not meet full criteria for a diagnosis, for example because the symptoms are fewer or less severe, but which nevertheless can be identified and related to the "full-blown" syndrome.

A culture-bound syndrome is a set of symptoms where there is no evidence of an underlying biological cause and which is only recognized as a "disease" in a particular culture.

When do symptoms become a disease ?

Aronowitz RA - Ann Intern Med 2001; 134 Suppl: 803-808

When do symptoms become a disease ? Are there rules or norms, currently or in the past, that tell us when a particular collection of largely symptom-based criteria has enough specificity, utility or plausibility to justify the appellation disease ?

The history of numerous symptom-based diagnoses in use today suggests partial answers to these questions. The 19th-century shift to understanding ill health as a result of specific diseases, increasingly defined more by signs than symptoms, led to a loss of status for illnesses that possessed little clinical or laboratory specificity.

Nevertheless, clinicians then and now have used symptom-based diagnoses. Some of these diagnoses owe their existence as specific diseases to the norms and practices of an older era much different from our own. Others have not only thrived but have resisted plausible redefinition done by using more “objective” criteria. Many strategies, such as response-to-treatment arguments, quantitative methods (for example factor analysis) and consensus conferences, have been used to find or confer specificity in symptom-based diagnoses. These strategies are problematic and have generally been used after symptom-based diagnoses have been recognized and defined.

These historical observations emphasize that although biological and clinical factors have set boundaries for which symptoms might plausibly be linked in a disease concept, social influences have largely determined which symptom clusters have become diseases.